Department of Neurosurgery, Mohammed V Military Teaching Hospital, University of Mohammed V Souissi, Rabat, Morocco.
World Neurosurg. 2012 Feb;77(2):375-80. doi: 10.1016/j.wneu.2011.07.017. Epub 2011 Nov 7.
Paraspinal textiloma (ParaTex) is a well-known complication after posterior lumbar surgery. However, there are few articles on this topic, probably because of medicolegal concerns. In addition, patients with ParaTex can remain asymptomatic for months or even years unless it causes complications. The purpose of this study is to review our experience on this "undesirable" topic to increase awareness among spinal surgeons and radiologists and avoid unnecessary morbidity, which is still being encountered.
This study is a retrospective case series of six patients with ParaTex who underwent posterior lumbar spinal surgery in our neurosurgical department between January 2000 and December 2010. The medical records of each patient were reviewed and demographic data, clinical characteristics, initial diagnosis, surgical procedures, time interval between operation and onset of symptoms, biological and radiologic findings, treatment, and outcome were analyzed.
The six patients included four women and two men with a mean age of 48 years. Four patients had a history of lumbar disc herniation, one had undergone a laminectomy for a lumbar spinal stenosis, and a Gill's procedure was performed in one patient with a lumbar spondylolisthesis. The time from the causative operation to presentation ranged from 2 months to 6 years. All patients presented with nonspecific lower back pain and/or surgical site infection without fever or neurological symptoms. Laboratory parameters showed increased blood sedimentation rates and/or C-reactive protein level in four patients. Bacteria were isolated in only one patient. Five patients were evaluated with computed tomography scan, and this showed the spongiform pattern with gas bubbles in three cases. Magnetic resonance imaging was performed in two patients. The signal intensity varies according to stage and fluid content of the lesion. The ParaTex was removed surgically in all patients with a good outcome.
ParaTexs are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure. On computed tomography scan, the classic spongiform appearance is highly suggestive. Magnetic resonance imaging findings are variable and less specific, but confrontation of imaging data with the surgical history helps with the preoperative diagnosis. In the early postoperative period symptoms are related to the exudative response; at later times symptoms may be linked to pseudotumor formation clinically and radiologically. Appropriate antibiotic therapy is recommended when a septic complication is present or suspected. Strict measures must be taken to prevent this complication. Surgical sponges should always be counted at least three times (preoperatively, at closure, and at the end), radiopaque markers should be used, and if there is doubt, intraoperative radiography must be performed.
脊柱后路手术后发生的脊柱旁纺织物异物（ParaTex）是一种众所周知的并发症。然而，关于这个主题的文章很少，这可能是因为医学法律方面的考虑。此外，除非引起并发症，否则患有 ParaTex 的患者可能会在数月甚至数年内无症状。本研究的目的是回顾我们在这个“不理想”主题上的经验，以提高脊柱外科医生和放射科医生的认识，并避免仍然存在的不必要的发病率。
本研究是对 2000 年 1 月至 2010 年 12 月期间在我们神经外科部门接受脊柱后路手术的 6 例 ParaTex 患者的回顾性病例系列研究。回顾了每位患者的病历，分析了人口统计学数据、临床特征、初始诊断、手术过程、手术与症状出现之间的时间间隔、生物学和影像学发现、治疗和结果。
6 例患者包括 4 名女性和 2 名男性，平均年龄为 48 岁。4 例有腰椎间盘突出症病史，1 例因腰椎管狭窄症行椎板切除术，1 例因腰椎滑脱行 Gill 手术。从致病手术到出现症状的时间范围为 2 个月至 6 年。所有患者均表现为非特异性腰痛和/或手术部位感染，无发热或神经症状。4 例患者的血液沉降率和/或 C 反应蛋白水平升高。仅 1 例患者分离出细菌。5 例患者行 CT 扫描，3 例显示海绵状伴气泡。2 例患者行磁共振成像检查。病变的信号强度根据阶段和液体含量而变化。所有患者均行手术切除 ParaTex，结果良好。
ParaTex 在肥胖患者、急诊手术后和手术过程中出现计划外变化时更为常见。在 CT 扫描上，典型的海绵状外观高度提示。磁共振成像表现多样且特异性较低，但将影像学数据与手术史进行对比有助于术前诊断。在术后早期，症状与渗出反应有关；在后期，症状可能与临床和放射学上的假性肿瘤形成有关。当存在或怀疑感染性并发症时，建议使用适当的抗生素治疗。必须采取严格措施预防这种并发症。手术用海绵应至少清点 3 次（术前、关闭时和结束时），应使用不透射线标记物，如果有疑问，必须进行术中放射照相。
